The prevalence of posttraumatic psychopathology in the general and the clinical population

Since the beginning of psychiatry, there has been a controversy about the consequences of traumatic events. Although there is no real dispute about human suffering caused by extreme stress events, social scientists have wondered whether traumatic events could lead to lasting psychopathology. This dispute was very strong in the first two versions of the the diagnostic and statistical manual of the American Psychiatric Association, which came out in 1952 and 1968. In DSM I (1), trauma could only lead to "gross stress reactions", which were part of "transient situational personality disorders". Extreme stress events were thought to lead only to a transient/temporary disturbance and if there was more disturbance than that, another diagnostic label had to be found. This attitude towards trauma has changed over the years and from 1980, in DSM III, there emerged the Posttraumatic Stress Disorder, a disorder which can be lasting or transient (2). In the past years, it has become clear that posttraumatic stress disorders are not the only form of psychopathology that follows after traumatic events. Major depressive episodes and dissociative disorders can also follow traumatic events. In this article, the results of two studies are reviewed. The first is a survey of the major studies into the prevalence of disorders after traumatic events. The main conclusion of this study shows that about 20% of the people that go through severely distressing events develop severe disorders. The second study focuses on the prevalence of disorders in the process of coping with traumatic events in a psychiatric outpatient clinic. Results of this study showed that clinically significant signs of these disorders were found to be present in 18% of the psychiatric outpatient referrals. In the discussion, the conclusion is drawn that posttraumatic psychopathology is a phenomenon that every clinician is confronted with on a regular basis. We might then wonder why specific treatment for posttraumatic psychopathology is still such a neglected area in psychiatry and psychotherapy.